• Please Read Carefully and Completely.

• All clients are required to complete the Nutritional Health Assessment.

• We will schedule your appointment/consultation when we receive all forms and payment.

• Two passport sized photo's of yourself are required.

•  Follow steps 1, 2, & 3.

1. Complete the following forms: (#1- #8 Click Here)

• If you have questions while you are filling out the above forms, you may email your questions to ( This e-mail address is being protected from spambots. You need JavaScript enabled to view it ).

• Please put N.H.A. in the subject box. Failure to do so may leave your questions unanswered. 

2. Make sure you include copies of the following:

      • A copy of your most recent blood chemistry.

      • A copy of all medical records since you were first diagnosed.

• Two passport sized photo's. 

3.  Send all information plus payment in the amount of $535.00 to: 

 Bogazot

135 West liberty Street

Suite 5

Medina, OH 44256

570-350-3258

• Please DO NOT email this information to our office.

• Due to HIPPA laws, you can print a copy, fill it out and mail it to our office.

 "Professional Consultations and the Nutritional Health Assessment", performed by Bogazot D.C. and Susan Jensen in regard to H.T.M.A. & Nutritional Blood Analysis are separate and independent services. Although offered through Bogazot.com, they are not a part of the non profit portal or organizations supported by this site.